Drug Prescribing For Obese

DIJO MATHEW JOHN

PHARM.D POST BACCALAURATE
MANIPAL
 Drug Dosing in Obesity
Obesity BMI> 30
Drug dosing is difficult as there is only limited
information is available.
It is estimated that by 2010, 40% of the US adult
population will be obese.
Obesity increases the risk of multiple disease states
including hypertension, diabetes mellitus, and
coronary artery disease.
 Calculations

BMI = Weight in kilogram/Height in m2

Ideal Body Weight Calculations :

Males = 50 + 2.3(Ht >60 inches)
Females = 45.5 + 2.3(Ht>60inches)
 Physiological changes in obesity

 dramatically increased adipose tissue

 slightly increased lean tissue mass
 increased cardiac output
 increased glomerular filtration rate
 fatty infiltration of liver
 Phamacokinetics in obesity

Oral availability (F)

 Oral availability in obese patients does not appear to

be different from in non-obese patients.
 Volume of distribution

Hydrophilic drugs : generally no change in Vd. e.g.

lithium.
Lipophilic drugs : Increased adipose tissue mass can
influence Vd.
e.g. aminoglycosides To prevent overdosing in
obesity, a dosing weight correction factor of 0.4 is used
to account for the altered volume of distribution.
 Metabolism

Phase 1 reactions unchanged in obesity

Phase 2 reactions increased in obesity.

Eg: Lorazepam, Oxazepam
Increased metabolism of this drugs may result in
suboptimal concentration.
Fatty infiltration of liver may occur in obese patients.
 Elimination

Renal clearance
 Glomerular filtration increases in obesity resulting in
increased clearance of many renally cleared drugs.

 Tubular function i.e. tubular secretion and reabsorption

of some drugs may also be increased in obesity.
Estimation of Cr.Cl in Obesity
 Recommendations

 Be aware that obese patients may require dose adjustment

especially for low therapeutic index drugs.
 Maximum recommended doses should not normally be
exceeded.
 Monitor the effects of medication both clinically and with
therapeutic drug monitoring if appropriate, and be prepared to make
dose adjustments.
 Larger loading doses may be required..
 Maintenance dose – for most drugs should be based on
Lean Body Weight, a weight of approximately
Ideal weight + ⅓ X (Total weight – Ideal Weight)